Cardiovascular disease (CVD) rates have increased dramatically among American Indians in recent years. Modifiable CVD risk factors, such as obesity, type 2 diabetes, sedentary behavior, and tobacco use are generally higher in most American Indian communities compared to non-Hispanic whites, although there is limited understanding of the unique cultural aspects of appropriate CVD primary prevention strategies in these populations. The Lumbee Indian tribe, a non-reservation tribe with a population of about 50,000, is the largest American Indian tribe east of the Mississippi River, and is largely concentrated in Robeson County, in southeastern North Carolina (NC). This county is largely rural, has a high poverty rate, and is almost equally divided among American Indians, African Americans and non-Hispanic whites. Limited available data indicate that CVD and its risk factors are very high among American Indians in North Carolina in general and Lumbees in particular. The Lumbee tribe is largely Christian, and the church is a very important component of Lumbee culture, providing opportunities to develop church-based health interventions in this population. The proposed project, entitled, "The Native Proverbs 31 Health Project," is in response to RFA-MD-10-004 (NCMHD Innovative Faith-based Approaches to Health Disparities Research). This project is designed to develop, implement and evaluate a CVD prevention program among Lumbee Indian women in Robeson County, NC, focusing on the biblical messages in Proverbs 31. The following aims will be performed 1) Based on prior research and formative work in the community, collaboratively develop a community-based, culturally appropriate CVD intervention program for Lumbee Indian women in Robeson County, NC, focusing on the health-related messages in biblical passage in Proverbs 31;2) Implement a 6-month CVD intervention program in four Lumbee Indian churches in Robeson County, NC, using a community health / lay health educator model. 3) Evaluate the community-based, culturally appropriate CVD intervention program on diet, physical activity and tobacco use among Lumbee women using a two-armed randomized trial with a cluster design and delayed intervention for control churches. Our primary outcomes for this study will be changes in health behaviors (diet, physical activity) and movement along the transtheoretical model stages of change for tobacco use. Secondary outcomes will include changes in body mass index (BMI) and changes in self-efficacy and self-esteem. We will conduct process assessments to determine the level of feasibility in the development and delivery of the intervention materials. This model could be adapted for other American Indian churches as well as churches of other racial/ethnic groups. PUBLIC HEALTH RELEVANCE: Project Narrative The proposed project entitled The Native Proverbs 31 Health Project is in response to RFA-MD-10-004. The project is designed to develop, implement and evaluate a church-based CVD prevention program among Lumbee Indian women in Robeson County, NC. The program will focus on an educational curriculum based on the biblical messages in Proverbs 31, which focuses on the behaviors of the "virtuous woman." The primary outcomes include changes in diet, physical activity and tobacco use and secondary outcomes in BMI, self-efficacy and self-esteem.